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INTRODUCTION Individuals with Down syndrome (DS) are at risk for Alzheimer's disease (AD). However, diagnosis remains challenging due to variability of intellectual ability and symptom presentation. To investigate whether serum AD biomarkers enhance accuracy of the German version of the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID‐G), we combined test scores with neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) levels. METHODS Seventy‐eight DS individuals (49% female) completed the DSQIID‐G; previous cohort data were added for a pooled sample (n = 164, 47% female). Serum NfL and GFAP were assessed using the automated microfluid Ella system. RESULTS Combining the DSQIID‐G with NfL or GFAP resulted in improved accuracy in every diagnostic subgroup. The Youden index in the pooled samples yielded a cut‐off score at 6.5. DISCUSSION The DSQIID‐G is a robust screening tool and its combination with AD blood biomarkers aids earlier identification of individuals requiring further diagnostics for DS‐associated AD. Highlights The German version of the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID‐G) is a reliable screening tool for suspected cognitive decline in adults with Down syndrome (DS). A cut‐off score of 6.5 optimizes DSQIID‐G performance for a sensitivity > 80%. Adding neurofilament light chain or glial fibrillary acidic protein to the DSQIID‐G further improves discriminatory power for DS‐associated Alzheimer's disease. The combined screening–biomarker approach holds promise for early detection of cognitive decline in DS.

Background: Dementia is an emerging public health challenge in India, particularly among older adults in rural and underserved regions. Early detection is crucial for timely intervention and care planning. However, existing screening tools, such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), have limitations in low-literacy populations due to their reliance on reading, writing, and numeracy skills. In India's primary healthcare (PHC) settings-where time, training, and resources are limited-there is a critical need for a culturally appropriate, easy-to-administer cognitive screening tool. Objective: This study aimed to develop and validate a brief, culturally relevant, and literacy-independent tool-the Primary Healthcare Cognitive Screening (PHC-CS) tool-for the early detection of cognitive impairment among adults aged 50 years and above in Indian primary healthcare settings. Methods: The PHC-CS tool was developed through a multistep process, including a literature review, expert consultation, and field testing. The final 21-item tool assessed eight cognitive domains (memory, attention, language, visuospatial ability, executive function, orientation, constructional ability, and mental flexibility) using orally delivered tasks supported by visual aids. The tool was administered to 172 participants at a rural PHC in Karnataka. MoCA scores and neurologist-confirmed ICD-10 diagnoses served as reference standards. Psychometric validation included ROC curve analysis, internal consistency (Cronbach's alpha), test-retest reliability, and interrater agreement. Results: At an optimal cutoff score of <45, the PHC-CS tool demonstrated an area under the ROC curve of 0.957 (95% CI: 0.922-0.992), with a sensitivity of 95%, a specificity of 92%, a positive predictive value of 96%, and a negative predictive value of 92%. Internal consistency was strong (Cronbach's alpha = 0.90), with good test-retest reliability (r = 0.88) and interrater agreement (κ = 0.88). The average administration time was 15 minutes. Conclusion: The PHC-CS tool demonstrates promising preliminary validity and feasibility for routine cognitive screening in Indian PHC settings, particularly for low-literate populations. Further multicentric validation is recommended.

Background Dementia has become a global public health problem, and general practitioners (GPs) play a key role in diagnosing and managing dementia. However, in Chinese primary care settings, dementia is underdiagnosed and inefficiently managed, and dementia screening and management services provided by GPs are suboptimal. The reasons underlying this gap are poorly understood. This study aimed to determine the barriers that hinder GPs from actively promoting dementia screening and management, and thereby provide insights for the successful promotion of dementia screening and management services in primary care. Methods Purposive sampling was used. And focus groups and in-depth interviews were conducted face-to-face among GPs from community health service centers (CHSCs) in South China. Thematic analysis was used to identify barriers to screening and managing dementia and map them to the Capability/Opportunity/Motivation-Behavior model (COM-B model). Results Fifty-two GPs were included. The COM-B model found nine barriers to implementing dementia screening and management services in primary healthcare: (1) poor capability: lack of systematic knowledge of dementia and inadequate dementia screening skills; (2) little opportunity: unclear pathways for referral, insufficient time for dementia screening and management, lack of dementia-specific leaders, and no guarantee of services continuity; (3) low motivation: outside of GP scope, worries associated with dementia stigma rooted in culture beliefs, and insufficient financial incentives. Conclusions Our study concluded that GPs were not yet ready to provide dementia screening and management services due to poor capability related to knowledge and skills of dementia, little opportunity associated with an unsupportive working environment, and low motivation due to unclear duty and social pressure. Accordingly, systematic implementation strategies should be taken, including standardized dementia training programs, standardized community-based dementia guidelines, expansion of primary care workforces, development of dedicated leaders, and the eradication of stigma attached to dementia to promote dementia screening and management services in primary care.

Alzheimer’s disease (AD) is the most prevalent form of dementia, yet its early detection remains challenging due to the invasiveness, cost, and limited accessibility of current diagnostics. Increasing evidence suggests that retinal changes mirror cerebral pathology in AD, making the eye a promising site for non-invasive biomarker discovery. Here, we present a technique employing a custom-built tri-spectral retinal imaging module, designed to be integrated with existing fundus imaging systems, that captures retinal reflectance across three optimized spectral bands to quantify spectral alterations linked to AD. We validate the system in a case-control study of 38 mild AD patients and 28 age-matched controls, revealing spatially resolved differences in a fundus map derived from the blue-to-green ratiometric channel ( p  < 0.001). Our analysis identifies specifically the fovea-to-optic disc region as the most discriminative for AD, with an AUC of 0.74. Building on this, we developed a biologically informed machine-learning classification model incorporating spectral, clinical, and demographic data. On an independent validation test, the model achieved an AUC of 0.91, matching or slightly outperforming the most advanced spectral retinal measurements, yet using a simpler, more stable, and cost-effective setup that further facilitates clinical translation. The demonstrated technology, thanks to its non-invasiveness and its integrability with both existing medical technologies and advanced quantitative statistical methods, holds the potential to drive a significant leap forward in the early detection of AD, opening a window for timely intervention and thus profoundly impacting patient care.

Background: Despite evidence that early identification of dementia is of growing policy and practice significance in the U.K., limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice-based evidence on the utility, efficacy and quality of dementia screening measures. Method: The study has three elements: a review of research literature, a small-scale survey of measures employed in three primary care trusts, and a systematic clinical evaluation of the most commonly used screening instruments. The study integrates data from research and clinical sources. Results: The General Practitioner Assessment of Cognition (GPCOG), the Memory Impairment Screen (MIS), and the Mini-Cognitive Assessment Instrument (Mini-Cog) were found to be brief, easy to administer, clinically acceptable, effective, and minimally affected by education, gender, and ethnicity. All three have psychometric properties similar to the Mini-mental State Examination (MMSE). Conclusions: Although the MMSE is widely used in the U.K., this project identifies the GPCOG, MIS and Mini-Cog as clinically and psychometrically robust and more appropriate for routine use in primary care. A coherent review of evidence coupled with an indepth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

The increased pressure on primary care makes it important for other health care providers, such as community pharmacists, to collaborate with general practitioners in activities related to chronic disease care. Therefore, the objective of the present project was to develop a protocol of action that allows close pharmacist-physician collaboration to carry out a coordinated action for very early detection of cognitive impairment (CI). Methods: A comparative study to promote early detection of CI was conducted in 19 community pharmacies divided into two groups: one group with interprofessional collaboration (IPC) and one group without interprofessional collaboration (NonIPC). IPC was defined as an interactive procedure involving all pharmacists, general practitioners and neurologists. A total of 281 subjects with subjective memory complaints were recruited. Three tests were used in the community pharmacies to detect possible CI: Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Individuals with at least one positive cognitive test compatible with CI, were referred to primary care, and when appropriate, to the neurology service. Finally, we evaluated the differences in clinical and diagnostic follow-up in both groups after six months. Results: The NonIPC study group included 38 subjects compatible with CI referred to primary care (27.54%). Ten were further referred to a neurology department (7.25%) and four of them (2.90%) obtained a confirmed clinical diagnosis of CI. In contrast, in the IPC group, 46 subjects (32.17%) showed results compatible with CI and were referred to primary care. Of these, 21 (14.68%) were subsequently referred to a neurology service, while the remaining 25 were followed up by primary care. Nineteen individuals out of those referred to a neurology service obtained a confirmed clinical diagnosis of CI (13.29%). The percentage of subjects in the NonIPC group referred to neurology and the percentage of subjects diagnosed with CI, was significantly lower in comparison to the IPC group ( p -value = 0.0233; p- value = 0.0007, respectively). Conclusions: The creation of IPC teams involving community pharmacists, general practitioners, and neurologists allow for increased detection of patients with CI or undiagnosed dementia and facilitates their clinical follow-up. This opens the possibility of diagnosis in patients in the very early stages of dementia, which can have positive implications to improve the prognosis and delay the evolution of the disease.

INTRODUCTION The Cognitive Change Index (CCI) is a brief questionnaire that assesses self and informant perceptions regarding cognitive function. We examined the ability of the CCI to distinguish between cognitively unimpaired (CU) older adults and those with mild cognitive impairment (MCI) or Alzheimer's disease (AD) dementia. METHODS 485 individuals from the Indiana Alzheimer's Disease Research Center (IADRC) and their study partners completed 20‐item self and informant versions of the CCI. Receiver operator characteristic (ROC) curves were analyzed to assess differentiation between CU and those with impairment. RESULTS High area under the ROC curve (AUC) values were obtained when using the self and informant CCI forms to distinguish CU individuals from those with impairment, with AUC values of 0.803 (95% confidence interval [CI] = 0.761–0.844) and 0.914 (95% CI = 0.886–0.942) for the self and informant forms, respectively. DISCUSSION The CCI can serve as a useful screening instrument in the context of a multimodal assessment strategy for MCI and dementia. Highlights Novel research that uses the Cognitive Change Index (CCI) for dementia screening. Our findings suggest that CCI can distinguish those with dementia compared to those without. These findings can be correlated to other screening instruments. Results could see the CCI play a role in early Alzheimer's disease (AD) screening and diagnosis.

Background/Objectives: Dementia is one of the leading causes of disability and dependence among older adults. Early screening may support timely intervention and risk management, contributing to better outcomes at the public health level. However, evidence relating to the factors influencing dementia screening acceptance and knowledge among older adults remains limited. This study aimed to assess dementia knowledge and screening acceptance among older adults, identify their associated factors, and explore the relationship between the two. Methods: A cross-sectional survey was conducted among 272 older adults in three Chinese communities. Data were collected using a self-administered questionnaire covering socio-demographic characteristics, dementia knowledge, and screening acceptance. The Dementia Knowledge Questionnaire and the Chinese version of the PRISM-PC scale were applied. Univariate and multivariate linear regression analyses were used. Results: The mean scores for dementia knowledge and screening acceptance were 18.86 ± 5.98 and 62.06 ± 22.18, respectively. Age and education level were negatively associated with screening acceptance. Women had higher knowledge scores than men. Income and social participation were positively associated with dementia knowledge. Knowledge level showed a weak positive correlation with screening acceptance. Conclusions: The study revealed that dementia knowledge and screening acceptance among older adults were moderate; nonetheless, both aspects warrant further improvement. Community-based efforts should prioritize health education, stigma reduction, and targeted interventions to enhance knowledge and promote proactive screening behavior.

INTRODUCTION Anticholinergic (AC) medication use is considered a risk factor for cognitive impairment and deterioration in the general population; yet, this has not been examined in Down syndrome (DS), a disorder with high dementia rates. METHODS Family members of 108 young adults with DS (18–39 years) reported on their loved one's medication use, executive function, and changes in cognition and behavior using a dementia screener. Medications were coded for their AC potency using the CRIDECO Anticholinergic Load Scale (CALS). RESULTS Forty percent of the sample was taking at least one medication with a CALS AC potency of ≥1. These individuals were reported to have greater executive function difficulties and more changes in cognition/behavior relative to those not taking AC medications. DISCUSSION AC medication use may represent a modifiable risk factor for cognitive deterioration in adults with DS; more research on this topic, particularly with older adults with DS, is needed. Highlights Identifying modifiable risk factors for dementia in Down syndrome (DS) is critical. A risk factor studied in the general population is anticholinergic (AC) medication. This risk factor has not been studied in DS, a high‐risk group. AC medication use was associated with everyday cognitive challenges in young adults with DS. Longitudinal studies across adulthood, including older adults with DS, are needed.

Screening all older adults for Alzheimer's disease and related dementias (ADRD) in primary care may not be acceptable or feasible. The goal of this study was to identify factors that could optimize screening in primary care and enhance its feasibility. This is a cross-sectional study in rural, suburban, and urban primary care practices in Indiana. A total of 1,723 patients ≥65 years of age were screened for ADRD using the Memory Impairment Screen. Logistic regression was used to identify patient-specific factors associated with screening positive for ADRD. The positive screening rate was 4.9%. Rates varied significantly across the three study sites. The rural site had the lowest rate (2.8%), which was significantly lower than the rates at the suburban (5.6%) and urban (6.6%) sites ( <0.01). Patient age, sex, and education were significantly ( <0.05) associated with screening positive for ADRD. Targeted screening of patients at risk for ADRD may represent a more optimal and feasible screening alternative to population screening.